| NPI | 1477989507 |
|---|---|
| Former Name | ANGELICA MARIE LOPEZ-GRIMAN |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH13694) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2013-09-20 |
| Last Update Date | 2024-02-12 |